As a speech-language pathologist I spend a lot of time studying the process of change. I think about learning and changing aspects of myself. I also think about how I might be able to help others make behavioral and cognitive changes that enable them to communicate more effectively and enhance the quality of life. 

Whether we stutter or not we are constantly making changes in our life. We know that change, especially major changes in the configuration and direction of our lives, can be difficult.  We take the steps of recognizing the need for change, contemplating how we are going to accomplish what we want, and eventually taking action to make our thoughts become reality.  As we alter and push the edges of our lives we expand our abilities and learn new, sometimes complex skills.  We experience anxiety and setbacks.  If what we want involves fundamental changes in ourselves and our environment, the process is likely to require discipline and a focus that will continue for months or years.  It will also require diligence and much practice. It is not surprising that the process of change is far from smooth and linear and that persistence is often the most important requirement for success.  Although change is often difficult it can also be exciting and fun. Therapy for stuttering is like that. 

The process of change during treatment for stuttering can be arduous but it can also be exciting and fun. I have had the opportunity to share the excitement and experience great joy while helping others to change. It is exciting to observe people challenge themselves and open up their world. It is fun to see people take part in and accomplish things they never suspected they could do, let alone do exceedingly well. This June I attended the annual meeting of the National Stuttering Association in Nashville, Tennessee, and was struck with how many sessions included the topic of humor as an essential part of self-help, support, and success in dealing with the problem of stuttering. The sessions were enjoyable and valuable both for the NSA members and the professional clinicians who attended. The experience reminded me that any clinician who is truly interested in understanding and helping people who stutter owes it to themselves and their clients to attend at least one of the annual meetings of the support groups that can be found throughout the world (see the Stuttering Home Page web site for a list of these organizations).

One of the reasons the process of treatment is exciting and fun for me is because I am often changing along with the client.  I rarely fail to gain new insights and ideas from the people with whom I share time.  We also share many emotions and often one of them is humor.  I especially appreciate the humorous events and insights that occur during the process of change. During productive, dynamic meetings, my clients and I find ourselves responding to the humorous aspects of the human condition and the specific set of circumstances we are attempting to alter within the experience of stuttering. 

Several years ago we began asking people attending our group therapy meetings to recall a humorous encounter they had experienced because of their stuttering.  Sometimes when we pose such a question the people who are in the early stages of therapy don’t understand. Some feel offended and think that the question is inappropriate since they don’t find anything remotely funny about stuttering.  But others in the group, those who are further along in the change process, come up with wonderfully humorous and insightful stories. As they relate their experiences, even the new members of the group spontaneously respond with laughter. That shared experience brings us together and typically provides the setting for a variety of new and insightful interpretations of our experiences.

As a result of our clinical experiences we began to read what we could find on the  therapeutic nature of humor.  At first we found relatively little for until the latter third of the 20th century there was little interest in the possibility that humor could have any therapeutic value. In the 1970s clinicians and researchers began to appreciate humor as a legitimate part of the human healing process, a way to maintain both physical and psychological health (McGhee & Goldstein, 1977). Some authors, particularly in the fields of psychology, counseling, and nursing, had reported some clinical success when applying research concerning humor. The literature suggested that humor was a valid and important feature of change. For example, the findings from several investigations indicated that humor reflects many of the affective and cognitive changes that occur as people achieve therapeutic success.  We found observations that suggested the potential of humor as an important variable; a variable that could both indicate and facilitate change for people who stutter.  For example, we found that

• Humor is considered to be essential attribute of a healthy and fully functioning person (Alport, 1937, 1961; Combs and Snygg, 1959; Maslow, 1968; Rogers, 1951, 1961).
• A person who possesses a sense of humor is better able to interact well with others than a person lacking humor; they tend to be more imaginative and flexible and correspondingly less likely to become obsessed with a particular issue or approach to a problem (Morreall, 1982).
• A person with a sense of humor is more likely to be open to suggestions from others and more approachable (Morreall, 1982).
• There is a close relationship (correlation of + .88) between insight and humor (Alport, 1961).
• A love of play is a fundamental aspect of the creative life and essential for change (Zinker, 1977).
• Humor has been positively correlated with the personality characteristics of enthusiasm, playfulness, hopefulness, excitement, and vigorousness and negatively correlated with fear, depression, anger, indifference, aloofness and religions fervor (McGhee & Goldstein, 1977).
• Recent studies have shown the a self-assessment Multidimensional Sense of Humor Scale (MSHS) designed to indicate one’s own behaviors towards humor is associated with a wide variety of psychological and social abilities. Using this scale, humor has been shown to correlate positively with such personality characteristics as exhibition, dominance, warmth, gregariousness, assertiveness, excitement seeking, arousability positive emotions, extraversion and cheerfulness (Thorson, et al. 1997).
• Humor, as measured by the MSHS, has been shown to correlate negatively with neuroticism, pessimism, avoidance, negative self-esteem, deference, order, endurance, aggression, depression, death anxiety, seriousness, perception of daily hassles, and bad mood (Thorson, et al. 1997).
• Individuals with a greater sense of humor are lower in deference and higher in extraversion, more likely to take the initiative in social interactions, willing to expend effort to create humor, and have a greater willingness and ability to communicate.  (Thorsen & Powell, 1993)
• Humor helps to draw the patient and therapist into a closer alliance. The potency of humor in psychotherapy relates to the attributes of intimacy, directness and humaneness (Rosenheim, 1974).
• Humor may be used as an antiexpectancy device to help lessen the severity of stuttering (VanRiper, 1973).
• People who stutter may learn to joke about their stuttering in order to become more open about their problem, as a way of helping others feel more at ease, and as a way of helping to transfer skills to beyond treatment settings (Bryngelson, 1935; Luper & Mulder, 1964; Guitar, 1998).

Although these findings indicate the obvious utility of humor during therapeutic intervention, we found few applications that were specific to stuttering.  Even so, we thought these comments clearly indicated the potential of recognizing humor as an important factor during stuttering therapy. 

But why do humans interpret events as humorous? Some appreciation of this wonderfully unique human characteristic provides insight about how humor can contribute to the clinical relationship and to therapeutic change for a problem such as stuttering.  One way to approach humor is by discussing the concepts of conceptual shift, distancing, and mastery.

Humor as a Variable for Indicating Change

Conceptual Shift

We often respond with laughter as we experience a sudden conceptual shift  (Morrell, 1982). Morrell suggested that the essence of humor is found in the enjoyment of incongruity and associated with this incongruity is a conceptual shift in the way we consider an event. This shift is most effective when it is immediate and the change in our conceptual state is relatively large. To the extent that we are able to predict or anticipate the shift (we have heard the joke or story before), the humorous response decreases. Similarly, Davis and Farina (1970) stress the importance of contradiction or incongruity as well as the integration of contradictory ideas or concepts. They also argue that the paradoxical views must be presented suddenly. Importantly, these authors also emphasize that a rapid shift in our understanding often leads to new insights about the concepts that are being contrasted.  Authors in fluency disorders have suggested that an integral part of a comprehensive behavioral treatment strategy involves the client’s development of a new belief system, a conceptual shift, about the self and the problem (Cooper, 1993; Covey, 1989; DiLollo, Neimeyer, and Manning, 2002; DiLollo, Manning & Neimeyer, 2003; Fransella, 2003; Kuhlman, 1984; Hayhow & Levy, 1989, Peck, 1978; Van Riper, 1973).

Distancing

It is, of course, difficult or impossible to find humor in a situation when are overwhelmed and feeling helpless.

You disembark from a train at a station in a foreign country. You don’t speak the language and are unable to communicate with anyone. People rush by and are unable (or refuse) to help you. You cannot locate a taxi. You need directions to your hotel and have no idea which way to go or how far it might be.  You are lost, anxious, and frustrated.

Whether you stutter or not, we have all had such feelings in a variety of speaking and non-speaking situations.  The experience is far from pleasant and certainly not funny. 

As days or weeks pass you are able to distance yourself from the event. You slowly begin seeing the paradoxical and often humorous characteristics of your experience.  You are able to view your adventure from a broader perspective and from a variety angles. You develop a degree of objectivity and often some insight about your experience. Time and a new cognitive perspective allows you to create an altered interpretation.

Many times, as a result of our reinterpretation of such adventures, a recounting of the experience becomes a favorite story.  As Sullivan (1954) suggests, humor may be thought of as “the capacity for maintaining a sense of proportion in the tapestry of life” (pp. 181-182). 

Mastery

Everyone has observed children spontaneously laugh as they discover the solution to a puzzle or problem.  They are demonstrating what Kuhlman (1984) indicates is the close connection between mastery and humor.  Laughter is a common by-product of the child’s shift from one cognitive stage to another.  As Levine (1977) suggests, problem solving, especially when the experience is a new one, is often exhilarating.  For example, Lefcourt and Martin (1989) found that mastery of a task or experience is closely tied to the expression of humor. Although adults are not generally as spontaneous as children about expressing joy or humor when mastering a new task, we have all experienced the relief associated with the successful completion of a new or particularly daunting activity. Individuals who have shared such activities (being lost or delayed while traveling, experiencing severe storms, undergoing difficult athletic or physical activities, taking part in difficult intellectual challenges, being stuck in awkward or embarrassing social occasions) often respond in a variety of humorous and creative ways. 

Over the years, several authors and researchers have suggested that humor facilitates a cognitive reorientation in the face of stress (Freud, 1928; Martin & Lefcourt, 1983; Nezu, Nezu, & Blissett, 1988).  Likewise, one’s ability to appreciate humor is related to a person’s internal locus of control, an indication of how much the individual perceives events as a consequence of his or her own behavior. Lefcourt, Sordoni, & Sordoni (1974) found that adults who hold an internal locus of control were found to smile and laugh more in the face of stress. In addition, Martin and Lefcourt (1984) found that people with better internal locus of control scores demonstrate greater ability to take multiple perspectives when problem solving and were more likely to consider alternative constructions for their experiences.

It appears that indicators of one’s successful response to a problem are reflected by the person’s ability to achieve (1) distance from the experience, (2) a degree of mastery over the situation, and (3) a conceptual shift that allows alternative interpretations. The facilitation of and the appreciation of humor may indicate these changes.  For some speakers who have a long history of avoidance and withdrawing from speaking situations, the cognitive changes that are reflected by a humorous response to the situation may be a better indicator of therapeutic progress (particularly in terms of cognitive change) than overt measures such as the frequency of stuttering.  In other words, humor may be thought of as a dependent variable in determining change and progress during therapy.  The clinician who has an appreciation of how humor may reflect such cognitive change is more likely to value and highlight these events.  Skilled clinicians may also want to view humor as an independent variable that may be used or manipulated in order to facilitate change in the desired direction.  

Humor as a Variable for Facilitating Change 

Along with appreciating humor as a metric of change in our clients, the clinician who is aware of the healing potential of humor can use this understanding to facilitate change.  Given that a humorous view of the situation often allows the discussion of sensitive topics and encourages the expression of unique ideas and solutions, the clinician may want to take the opportunity to look at the situation via the “third eye of humor”.  When we detect the potential for an element of humor in an inaccurate or narrow interpretation of a situation we may want to respond with a slight smile or quizzical look.  It may open the door for an alternative view. Certainly a humorous response may promote a wider view of a situation as well as the consideration of alternative explanations. As our clients experience success in achieving desensitization about the stuttering experience, begin to master fluency enhancing and modification techniques, develop problem solving abilities, decrease avoidance behaviors, and improve their risk taking and assertiveness, they will gain some distance from and be less overwhelmed by the fact that they stutter. They will begin achieving some mastery of their speech and their communication abilities.  And, perhaps most important, they will gradually achieve a conceptual shift about their role as a communicator.

A brief note of caution about humor and the therapy process.  At the outset of treatment the client is unlikely to see anything funny about this serious problem. Just as in any relationship, we won’t be likely to incorporate a humorous interpretation of the circumstances we are presented with until we have become somewhat calibrated to this person. Clearly, we should avoid using humor to deny the client’s pain or fear, conceal hostility (especially sarcasm) toward the client, demonstrate our ability and cleverness, or do anything to cause the client to doubt that we are taking him seriously (Haig, 1986; Kubie, 1970).

Our use of humor, just as other therapy or counseling techniques, should be coincide with our personality.  For example, it has been suggested that the use of therapeutic humor can not necessarily be taught but is more a product of therapist’s personality and outlook on life (Chapman & Chapman-Santana, 1995).  And, as with any therapeutic technique, it is not the technique but when and how we integrate a technique into who we are and how we are interacting with the person during the therapeutic alliance.  Often it is the nonverbal aspects of humor that make it work – our tone of voice, facial expressions, small gestures, slight changes of body tone and posture. Of course pauses and timing can also be critical. For a response to be humorous it must be spontaneous rather than or forced (Chapman & Chapman-Santana, 1995). If you are not comfortable using humor in the treatment setting it is not likely to be beneficial.

Nevertheless, there will be many opportunities throughout the therapeutic process to identify and utilize the power of humor. As clinicians, we can take opportunities to tell humorous stories about past events in our own lives that reveal moments of helplessness, embarrassment, anxiety, or loss of control. Such stories indicate our understanding of similar feelings being experienced by the person we are helping. The stories also reveal our characteristics of genuineness, warmth, and humanness that often contribute to the therapeutic alliance (VanRiper, 1975; 1979). We can look for examples of success that are reflected in a new and often humorous interpretations of the stuttering experience. We may suggest to clients or groups of clients that they reflect on past events (verbally or by journaling) to see if they can discover elements of humor in the current re-telling of their stories from the past.  We have found that humor can be an exciting and rewarding feature of treatment.  It can help to open the possibilities for new understanding and make the journey enjoyable. We all have these stories and if we spend time helping people who stutter, many of them are related to stuttering. If you have a humorous story I would like to suggest that you respond to this presentation with one or your own (or send it to me at wmanning@memphis.edu).

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-Discussion-

August 26, 2003